Document Detail


Outcome correlation of smear-positivity for acid-fast bacilli at the fifth month of treatment in non-multidrug-resistant TB.
MedLine Citation:
PMID:  23288018     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Sputum samples from patients with non-multidrug-resistant (non-MDR) pulmonary TB may remain smear-positive for acid-fast bacilli (AFB) at the fifth month of anti-TB treatment. However, its significance remains unknown.
METHODS: From January 2004 to April 2009, there were 5,403 patients with culture-confirmed pulmonary TB from four hospitals in Taiwan. Among them, 116 patients (2.2%) with non-MDR TB whose sputum samples were smear-positive by concentration smear method at the fifth month of treatment were evaluated.
RESULTS: Sputum culture yielded Mycobacterium tuberculosis in 10 patients (8.6%, MTB group), nontuberculous mycobacteria in 23 (19.8%, NTM group), and no growth in the remaining 83 (71.6%, no-growth group). The relapse rate (22%) was higher in the MTB group (P = .01). Four predictors, smear grading ≥ 3+ at the fifth month ("S") (OR, 10.73; 95% CI, 2.67-43.17), no sputum culture conversion on the second month ("C") (OR, 7.16; 95% CI, 1.45-35.44), lack of directly observed therapy ("O") (OR, 6.40; 95% CI, 1.54-26.56), and no radiographic improvement at the fifth month ("R") (OR, 4.18; 95% CI, 1.02-17.10), were associated with viable M tuberculosis (MTB group). An integrated "SCOR" index of 1 point for each positive factor had the best discriminatory power for predicting culture results at the fifth month. If the SCOR index was 0, all smear-positive sputum was culture-negative for M tuberculosis.
CONCLUSIONS: Positive sputum smears by a concentrated smear method at the fifth month of treatment in patients with non-MDR TB, especially those with a low SCOR index, may be due to nonviable bacilli and NTM. Careful review of the quality of patient supervision, bacteriologic data, and chest radiography is crucial.
Authors:
Jung-Yien Chien; Yi-Ting Chen; Chin-Chung Shu; Jen-Jyh Lee; Jann-Yuan Wang; Chong-Jen Yu; Pan-Chyr Yang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chest     Volume:  143     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-06-04     Completed Date:  2013-08-20     Revised Date:  2013-12-24    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1725-32     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Antitubercular Agents / therapeutic use*
Data Interpretation, Statistical
Directly Observed Therapy
Female
Humans
Male
Middle Aged
Mycobacterium tuberculosis / isolation & purification
Nontuberculous Mycobacteria / isolation & purification
Recurrence
Sputum / microbiology*
Taiwan / epidemiology
Time Factors
Treatment Outcome
Tuberculosis, Pulmonary / drug therapy*,  epidemiology,  microbiology*
Chemical
Reg. No./Substance:
0/Antitubercular Agents
Comments/Corrections
Comment In:
Chest. 2013 Oct;144(4):1423-4   [PMID:  24081365 ]
Chest. 2013 Oct;144(4):1423   [PMID:  24081366 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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